Provider Demographics
NPI:1952056053
Name:IHEDINACHI, UZODINMA
Entity Type:Individual
Prefix:
First Name:UZODINMA
Middle Name:
Last Name:IHEDINACHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:UZODINMA
Other - Middle Name:
Other - Last Name:IHEDINACHI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3013 KASPAR CT
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-5705
Mailing Address - Country:US
Mailing Address - Phone:703-362-2725
Mailing Address - Fax:240-523-7393
Practice Address - Street 1:3013 KASPAR CT
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-5705
Practice Address - Country:US
Practice Address - Phone:703-362-2725
Practice Address - Fax:240-523-7393
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRN177065163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD166104300Medicaid